A suicide screening procedure is only as effective as it ability to get at-risk students the care they need. Unfortunately little is known about service utilization by vulnerable youth following a suicide screening program. The overall aim of the present study is to examine help-seeking behavior, barriers to service use, and the relationship between symptom improvement and service use among a cohort of youth identified as at-risk in a school-based suicide screening project. A retrospective cohort study of youth identified as at-risk for suicidal behavior will be conducted. The cohort of at-risk teenagers (N=273) was identified during a two-stage screening program that was conducted in six schools in Nassau, Suffolk and Westchester counties in New York State from the fall of 2002 through winter of 2004. Each at-risk youth and his/her parent will be interviewed approximately two years after the screen to assess information on service use during the intervening period, barriers that may have interfered with seeking or receiving treatment, and the risk status of the youth at follow-up. The present project will expand our efforts to optimize youth suicide screening programs by establishing a better understanding of the naturalistic course of both suicidal adolescents' improvement and use of services after a screening program. This information is critically needed to guide our efforts to develop optimal help seeking strategies tailored to at-risk youth and their parents in order to establish effective screening Iprograms to prevent suicidal behavior in youth.